Pitchers Back in Game, but Not the Same After Surgery

NEW ORLEANS – Most baseball pitchers who undergo so-called "Tommy John" elbow collateral ligament surgery return to pitch again in the major leagues – although not at the same level before they were injured, researchers reported here.

Of the 186 major league pitchers who underwent the surgery pioneered by the late Dr. Frank Jobe, 87% returned to the 'Big Show', said Robert Keller, MD, a resident in orthopedics at Henry Ford Hospital, Detroit.

But when comparing how well they pitched when they returned to the major leagues, the pitchers who had the surgery appeared to have reduced effectiveness, Keller said at the annual meeting of the American Academy of Orthopaedic Surgeons.

When compared with how players pitched 3 years before surgery and how they pitched 3 years after surgery, determined Keller found:

Pitchers earned run average (ERA) increased -- that is, they gave up more runs per game to the opposition – from 4.15-4.74 (P=0.001).

Their WHIP – walks and hits allowed to opponent per inning – increased from 1.40 to 1.48 (P=0.011).

Innings pitched decreased from 59.81-50.28 (P=0.026).

Pitchers' winning percentage and their salaries did not change significantly, Keller said in his poster discussion session on sports medicine.

He said that in the year before surgery the average pitcher showed declines in earned run average, WHIP, innings pitches and winning percentage – probably an indication that they needed reconstruction surgery on their throwing arms.

"The incidence of Tommy John surgery is increasing among major league pitchers and the public impression of the positive effects of this surgery is also increasing," Keller said. "We aren't sure if that is because we are better at performing the surgery now, or better at diagnosing it."

Tommy John was a pitcher for the Los Angeles Dodgers who underwent the surgery at the hands of Jobe in 1974. He sat out the 1975 season and then returned to the major leagues and won 164 games after surgery. He won 288 games throughout his career.

Keller said that the study was undertaken because "we wanted to see what impact undergoing the surgery had on major league performance."

He and his colleagues accessed mainly information on statistics from publicly available sources.

The researchers suggested that pitchers who start their major league career at a younger age are at greater risk of needing the surgery. He said that 60% of the players in his cohort had 5 years or less of experience in the major leagues.

Poster discussion session moderator, Brian Cole, MD, professor of orthopedics at Rush University Medical Center, Chicago, who has also studied major league performance as it related to Tommy John surgery, said, "It is a good observation that a lot of these guy will pitch in pain before undergoing surgery. Many opt for surgery because they can see that their performance is suffering."

Cole said that previous studies have considered return-to-play rather than how well they perform after returning to the game.

Keller said that his study did not have access to player medical charts so the extent of injury was not available. None of the pitchers had more than one surgery, he said.

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